ONE NEUROLOGIST'S OPINION REGARDING STROKE TREATMENT AND PREVENTION

Stroke Prevention Trial: Aggrenox verus Plavix

In a major study (PRoFESS) completed in 2008, two anti-platelet drugs (Aggrenox and Plavix) were compared to each other. The implications of this trial are still filtering through the neurological community.

The trial involved, in part, placing patients who had suffering from an ischemic stroke on either Aggrenox (aspirin + extended release dipyrimadole) or Plavix (clopidogrel) within 90 days of their stroke. Patient who had strokes due to heart disease (cardioembolic strokes) were not included in the study. Patients were then monitored long-term for both side effects and new ischemic strokes.

The results? There was no significant difference in primary outcome (number of new ischemic strokes) between Aggrenox (9%) and Plavix (8.8%). There was, though, a slightly higher tendency for serious bleeding (major hemorrhagic events) in the Aggrenox group (4.1%) compared to Plavix (3.6%).

How has this result affected my prescribing?

This result has greatly affected my prescribing. Based on a previous trial (ESPS-2) I had formerly been in favor of Aggrenox as the clear favorite (over Plavix and aspirin) for secondary stroke prevention (stroke prevention after an initial ischemic stroke or transient ischemic attack). Now I would actually favor Plavix. The reasons are as follows:

(1) Plavix appeared to do as well or slightly better at preventing strokes (compared to Aggrenox)

(2) Plavix had fewer significant bleeding events

(3) Plavix is easier to take for patients (once a day versus twice a day).

(4) Patients who start Aggrenox often experience headaches.

(5) Cardiologists tend to favor Plavix for coronary artery disease (CAD) - so patients who have both ischemic stroke and CAD can be appropriately treated with Plavix.

Comments

I had a loss of half vision for 45 minutes that included tunnel vision, and was hospitalized. There was no haemorrhage in the brain and there were no clots in the heart as validated by echos and cathscan with and without contrast. I have been on Plavix 75 mg and baby aspirin last 10 years before since a loss of cosciousness for 1 1/2 hours but not passed out. There wasno memory at that incident. there were no no remnant stroke related neurological dificiencies in both cases. has been now placed only on Agrenox 2 caps a day in stead. This causes severe headaches. There is also talk of that these incidents may be only Migraine attacks. I always had episodes of tunnel vision,complaints about seeing and hearing, stammer car accidents that I could not expalain. Any suggestions? dwarku@yahoo.com

A stroke occurs when blood flow to the brain is blocked, either by blood clots or narrowed blood vessels, or when there is bleeding in the brain. Deprived of nutrients, brain nerve cells begin to die within a few minutes. As a result, a stroke can cause sensory and vision loss, problems with talking and walking, or difficulty in thinking clearly. In many cases, the effects of stroke are irreversible.

Having said all this, I suppose somewhere in the fog there is a point to it all. My best guess is this is an attempt to explain that when I complain about being exhausted; when I say I would love to do whatever but really, I need to sleep; when I actually sleep for several days and ignore emails and phone calls, it really is simply part of this disease I have. The very best analogy I can come up with only works for some people. I Sometimes I just feel like I've got mono to the power of ten.

Stroke Doc

Please Note

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This website will provide periodic updates about important stroke-related news. The site contains general information only and is not intended to replace a physician's advice. Please consult a physician to address your specific healthcare questions.